Provider Demographics
NPI:1073394474
Name:MAYO, FARRAH MARIE KINTE
Entity Type:Individual
Prefix:
First Name:FARRAH
Middle Name:MARIE KINTE
Last Name:MAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5858 S PECOS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-5404
Mailing Address - Country:US
Mailing Address - Phone:702-855-3382
Mailing Address - Fax:
Practice Address - Street 1:5858 S PECOS RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-5404
Practice Address - Country:US
Practice Address - Phone:702-855-3382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant